'Ridiculously long waits' at A&E causing patients to miss medicine doses
Patients in A&E are at risk of becoming more unwell due to missed doses of prescription medicines, a new report warns.
The Royal College of Emergency Medicine (RCEM) found that time critical medicines, such as insulin for people with diabetes, Parkinson's drugs, epilepsy medicines and blood clot medication, are not being delivered consistently across emergency departments.
If these drugs are delayed or missed, the patient can deteriorate and is at greater risk of complications or death.
While patients are advised to remember to bring their medications to A&E and to take them, there is also a responsibility on NHS staff to make sure this happens.
This problem has "risen to prominence" because of "the increasing number of our patients who are having to endure ridiculously long waits in our emergency departments", said RCEM president-elect, Dr Ian Higginson.
With many patients forced to wait "12, 24, 48 hours and even longer", Dr Higginson said it is "vital" that ensuring patients receive time critical medicine is "an issue associated with these waits".
'Missing doses of medication for illnesses such as Parkinson's or diabetes is not just inconvenient, it is dangerous; and missing multiple doses can have serious consequences," he added.
The new study focused on oral levodopa for Parkinson's and insulin for diabetes, as these are common in patients in A&E and must be given on time.
Finding from 136 emergency departments, who submitted date for more than 13,000 people in A&E on the two medications, found more than half were not identified as being on the medication within 30 minutes of their arrival.
In addition, 68% of doses were not administered within 30 minutes of the expected time.
The research is part of the college's clinical Quality Improvement Programme (QIP) which aims to improve the care of A&E patients.
Dr Higginson said that the first-year report does show improvements are being made across the country, this work must be "replicated in every emergency department" so that "no one fears not being able to access their medication while in our care".
Dr Jonny Acheson, an emergency medicine consultant with Parkinson's, who led the study, said there has been improvements but more needs to be done.
'The findings contained in this report should serve as a call to action for both emergency medicine staff, as well as patients reliant on time critical medications, to ensure no dose is ever missed in A&E,' he said.
'Everyone has a role to play – paramedics and emergency medicine staff need to ask patients what medications they take, and likewise, people with Parkinson's and insulin treated diabetes need to tell staff they take a TCM and take their meds with them if they have to visit an A&E.
'We are pleased that focusing on identifying these patients has led to improvement.
'However, the NHS must think about how they identify people taking these types of medication and how they are able to ensure they receive their doses on time, every time while they are in the emergency department.
'These medicines are critical to the quality of these patients lives and we have a duty of care to ensure that they receive them when they should.'
Recommendations made in the report included patients on time critical medication being identified early when attending A&E, and for systems to be in place to ensure timely administration of this medication, including self administration.
The report also says there should be a clear line of responsibility for staff.
The QIP team made recommendations, including that patients on TCM need to be identified early when they attend A&E to start the process of getting all doses.
Systems also need to be in place to ensure timely administration of TCM, including self-administration, and there should be a clear line of responsibility for staff.
An NHS spokesperson said: 'We welcome this report and will look closely at the findings, to ensure any patient in need of time critical medicine does not lose out when in A&E and receives the medication they need or support to self-administer as they would at home.
'As the report makes clear, it is welcome to see improvements thanks to the hard work of frontline staff but more generally we know A&E waiting times are far too long and our upcoming urgent and emergency care plan will set out how we aim to bring these down ahead of next winter.'
The Specialist Pharmacy Service (SPS), a team of pharmacy professionals commissioned by NHS England to provide guidance has issued advice on delayed or missed medication.
It says that "taking a medicine at the wrong time may reduce its efficacy", while taking subsequent doses too close together "may also increase the risk of side effects".
In the event that patients do accidentally miss a dose, the SPS advises they check the patient information leaflet supplied with their medicine for further guidance.
Alternitavely, you can find a copy on the electronic medicines compendium, the manufacturer's website, or the Medicines and Healthcare products Regulatory Agency (MHRA) website. The NHS website also contains a selection of medicine guides.
Each medication will have its own guidance, so it is important to check the instructions for the drugs perscribed to you, but the SPS has issued some more general advice:
Never take a double dose to make up for a forgotten dose, unless advised by a prescriber.
For most medicines, it is acceptable to take a dose up to two hours late.
You can usually ignore warnings about taking the medicine with or without meals, unless there's a significant risk of serious side-effects.
For patients who take their medicine once or twice a day who have missed a dose, they should take that missed dose as soon as remembered, as long as the next dose is not due within a few hours. After that they should continue taking the medicine as usual.
For patients who take more than two doses per day who have missed a dose, they should skip the missed dose and wait until the next dose is due. Then continue taking the medicine at the usual times.
Some medicines including antiseizure medications, insulin, oral contraceptives and Parkinson's disease medication carry a higher risk, meaning patients should follow specific guidance issued for these drugs.
You can find this guidance here on the SPS's website.
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